95 posts categorized "Health Policy"

03/01/2016

There has been a well-documented trend toward higher drug prices in the US. Turing Pharma turned heads by raising the price of Daraprim® by 5,000 percent, and there has been more news coverage of the practice of hiking drug prices. At the same time, new technologies and group purchasing power are being harnessed to counteract this trend. These two competing forces will help shape the ongoing debate on drug pricing.

In early February 2016, Blink Health announced the launch of its mobile app and website, purposed to help consumers secure the lowest possible retail price. Blink is not a retail pharmacy, but it works with MedImpact, a pharmacy benefits management company affiliated with 60,000 pharmacy locations. Users can supposedly get better prices on generics, because Blink can use its group purchasing power to negotiate lower prices. The app and website quote a price, which the user pays prior to going to the pharmacy. He/she still must provide a prescription to the retail pharmacy, but the price is secured for any of the affiliated locations.

Blink claims that users can save 80% on generics; that 40% of its medications cost less than $5; and, that 50% of its medications cost less than $10. The company claims that higher prices cause patients to skip doses and to stop the regimen entirely. They claim that their tool will help increase access to medications through lower prices.

Navigating drug pricing is notoriously labyrinthine. Most retailers do not post their prices and prices vary for different consumers and consumer types within the same market. Lisa Gill, deputy editor of Consumer Reports Best Buy Drugs is quoted by the NY Times saying, “The prices are all over the map, even within the same ZIP code.”

Since 2006, Wal-Mart, the world’s largest retailer, has been providing certain generics for $4 for a 30 day prescription. The company maintains a list of drugs that it provides at that price. The company provides this price by using its purchasing power, and by taking advantage of its distribution system. There are other programs, such as GoodRX, that aim to provide patients the lowest possible prices on generics. GoodRX is similar to Blink Health, but it provides coupons to be used at the retail site. Blink allows patients to pay for the drug prior to picking it up at one of the affiliated pharmacies.

Brand name drugs fall outside of the scope of these programs. In addition, generic drugs like Daraprim®, which is a sole-source product, will not likely be affected by these and similar price control programs. However, Wal-Mart, Blink, GoodRX and others are applying downward price pressure to the market for generic drugs. Whether this is sufficient to keep prices under control, overall, is yet to be seen. The companies leverage technology to secure lower prices. Consumers demand lower prices, and these services will survive and profit if they provide value to consumers. The prices they offer are closer to the prices paid by insurers.

High drug prices can have a deleterious effect on patient behavior. As Blink Health has claimed, higher prices often discourage patients from filling out prescriptions and often push them to skip doses. Tools that help patients secure drugs at lower prices, even if only in retail settings, should have a positive effect. A case can be made that these tools address only the symptom of higher prices and not the causes. Factors that drive up prices may be ignored, since these tools provide lower prices as an end result. Drug companies can refuse to address higher prices by pointing to these tools as proof that their drugs are ultimately affordable.

The ongoing drug price debate, fueled by Turing’s move and others, highlights the high cost of prescription medications. The new tools take advantage of the information gap between consumer and producers. They do provide a valuable service, although the debate continues. Should there be price controls on critical drugs? Should the US move to a single buyer system, as is the case in Canada and European countries? If so, Blink, GoodRX, and other similar businesses will be impacted, since they would be unable to provide lower prices than that set by the government.

02/15/2016

In September 2015, Turing Pharmaceuticals raised the price of Daraprim® (pyrimethamine) from $13.50 per tablet to $750. The 5,000 % price increase put the national spotlight on the practice of rising drug prices, including for generics such as Daraprim, which is used to treat toxoplasmosis infections. The company’s CEO, Martin Shkreli, has been vilified in the press and in social media, which has kept the subject in the public consciousness. The price hike by Turing, which had only acquired the drug that August, was seen by many as price gouging. Shkreli’s action has heightened scrutiny of drug pricing policies, and raised public awareness of the arbitrariness of pricing in the US market.

Shkreli defended the move, contending that the higher profitability means more funding will be available for toxoplasmosis research. If the market size is limited, then profitability would come through higher margins. The higher margins, Shkreli’s camp argues, compel manufacturers to produce enough of the drug to meet demand. No one who needed the drug has been unable to get it due to price, the company has claimed, and Turing provides support for those who are unable to afford it.

Turing also argues that it has been singled out for media attention for the practice of acquiring a drug and raising its price. Older drugs, such as Cycloserine®, a tuberculosis drug, and Doxycycline®, an antibiotic, have had their prices raised after acquisition. Valeant purchased Isuprel® and Nitropress® and subsequently raised the price for both. CBS News reported that a Bloomberg News study found that 20 prescription medications have had their prices quadrupled since 2014, and 60 drugs have had their drug prices at least doubled. The same study found that Novum Pharma raised the price of two anti-inflammatory steroids, Alcortin A® and Novacort®, by 2,000 and 3,000 percent respectively during that period. In this light, Turing’s move was not completely out of the norm.

Critics counter that such dramatic price increases are dangerous. The Infection Disease Society of America (IDSA) and the HIV Medicine Association (HMA) sent a letter to Turing warning that the practice was “unsustainable for the health care system” and posed a risk to public health. Social media has lambasted Shkreli for exploiting people with serious illnesses for the sake of profitability. Shkreli, his critics contend, is behaving more like a hedge fund manager than as a steward of the public health.

Since this story broke, more attention has been given to the practice of hiking drug prices such as at Gilead. The company is facing scrutiny for the cost of two hepatitis C medications, Sovaldi® and Harvoni®, which cost $84,000 and $94,500 respectively for each regimen. The attorney general of Massachussetts wrote a letter to Gilead, saying she was looking at whether drugs are overpriced, and whether to invoke consumer protection laws in that effort, which would be a first. Pfizer has faced criticism for hiking the prices of 100 drugs in the beginning of January 2016 and its planned merger with Allergan has emerged as an issue for Democratic presidential candidates Hillary Clinton and Bernie Sanders. Truveris, a research firm, found that drug prices had gone up by 10.4% since 2014, and that brand names have gone up by fifteen percent.

While Shkreli and Turing’s move was jarring, the public now knows that price increase are not extraordinary. New specialty drugs entering the approved drug market are further driving up prices. BY contributing to higher healthcare costs, price increases for existing drugs reduce the apparent effectiveness of health care spending. Prescription drugs make up a substantial portion of US national healthcare costs, which are highest in the world. The price increases lead to higher insurance payments and copays.

An investigation has been opened by the House Committee on Oversight and Government Reform. Ranking member, Rep. Elijah Cummings, released memos from a preliminary investigation which appeared to show that the price moves by Turing were purely for increasing profits, and that R&D costs were minimal. Shkreli testified before the House Oversight and Government Reform Committee on February 4, 2016, where he repeatedly invoked his Fifth Amendment right not to self-incriminate.

Shkreli was arrested in December 2015 for allegations of securities fraud prior to his takeover of Turing and has continued to draw public notoriety for his actions. He has, through his public defiance, caused the discussion to persist. It is notable that national vilification of Shkreli has contributed to the debate, demonstrating that personalities can impact policy as much as raw numbers.

Affordable medications are a crucial part of public health. Likewise, the profit motive provides an incentive for pharmaceutical companies to produce sufficient quantities of a particular drug. In the current system, a balance is needed. Turing’s price hike of Daraprim has heightened the scrutiny of a perceived imbalance towards profitability and away from affordability. With drug prices entering the presidential elections, it is likely that pricing will continue to be a major political issue.

08/26/2015

Dr. Stephen Metraux, professor of health policy and public health at University of the Sciences, has done extensive research on homelessness and housing, mental illness and community integration, prison reentry, and other aspects of urban health. In fact, he is working with the U.S. Department of Veterans Affairs as part of their commitment to ending homelessness among veterans by 2015.

The Journal of the American Medical Association [JAMA] on Aug. 25 published the results of research1 that he took part in to explore the association between misconduct-related separations and homelessness among recently returned active-duty military service members:

03/10/2015

Striving to address the healthcare needs in the LGBT community, University of the Sciences has teamed up with local nonprofit organizations to host its first Panel on LGBT Healthcare on Wednesday, April 1, from 7-9 p.m., in Griffith Hall (43rd Street at Woodland Avenue).

“This event is intended to bring together students and community members to learn more about the unique needs and challenges faced by the LGBT community in regards to accessing healthcare,” said AJ Young, coordinator of the event at USciences.

“Our speakers are some of the most knowledgeable and passionate people in Philadelphia regarding LGBT issues, and they’re eager to highlight what future healthcare professionals should know to provide quality care that treats LGBT patients with respect and dignity, while addressing their unique and not-so-unique health concerns,” said Young.

This event is free and open to the public, and light refreshments will be served after the panel. For more information, contact Young at a.young@usciences.edu or 215.596.8734.

12/05/2014

Whether patients are getting medications, seeing a primary care provider, discharged from a hospital, or getting emergency care, they are being shifted between different health care providers. Transitions of care is an important aspect of healthcare because it allows smooth movement of patients from one setting to another.

Transitioning from the hospital to home can be difficult for patients, potentially leading to readmission if the transition is not well coordinated. Kirkham conducted a retrospective cohort study in two acute care hospitals in the United States to see the effect of a collaborative pharmacist-hospital care transition care program on the likelihood of 30-day readmission rates. The two-year study showed patients who did not receive bedside delivery of post discharge medications and follow-up telephone calls were twice as likely to be readmitted within 30 days of discharged than those who did receive these services. For patients greater than 65 years of age, the pharmacist transition of care resulted in a six-fold decrease in 30-day readmission rates. As this study shows, a transition of care program can be associated with a lower likelihood of readmission and pharmacist participation can be of significant benefit.

A study conducted by Bellone reviewed 131 patients aged 18 to 65 on at least three prescription medications. The intervention group consisted of patients that pharmacists visited within 60 days of discharge to provide medication counseling or dosage adjustments, while the control group did not receive any intervention. The intervention group had an 18.2% hospital readmission rate compared to 43.1% in the control group (P = 0.002). Pharmacists can optimize medication adherence during transitions of care to reduce readmission rates. The American Pharmacist Association and American Society of Health-System Pharmacists released a Medication Management in Care Transitions Project to display popular models from across the country that improve patient outcomes by involving pharmacists in medication-related transitions of care. Some of the roles and responsibilities of pharmacists in these practices include: medication reconciliation, counseling on medication therapy, contacting the patient’s home for follow-up, preparing medications etc. Through these interventions pharmacists are involved in patient care from inpatient to home settings.

Transition of care pharmacists can be a beneficial aspect in the health care system. By providing appropriate interventions, pharmacists can decrease the likelihood of hospital readmission.

11/18/2014

Those fortunate enough to be somewhere warm during this recent cold snap might wonder how Philadelphia’s homeless population can survive the frigid outdoor conditions, said Stephen Metraux, PhD, associate professor of health policy and public health at University of the Sciences.

“Data on how many homeless are stuck out in the cold is difficult to come by,” said Dr. Metraux. “The homeless population is notoriously challenging to count, as they usually strive to stay inconspicuous amidst the public spaces to which they are relegated.”

The best available number comes from the City of Philadelphia’s annual “Point in Time” count, when teams of volunteers canvass the shelters and streets and count the number of homeless people and families that they encounter. Of the estimated 5,500 homeless individuals counted on a January night in 2013, 388 of them were unsheltered. That figure is down from the 526 individuals recorded on a January night in 2012.

So how do these hundreds of homeless individuals survive below-freezing conditions? The first line of defense is provided by the City of Philadelphia, which implements a “Code Blue” on any night when temperatures fall under or hover around 20 degrees, said Dr. Metraux.

On Code Blue nights, outreach workers and police can bring in any homeless person to stay in a shelter or other public facility temporarily designated for overnight accommodations. No one gets turned away and, if necessary, a Court Ordered Transportation to Shelter can be quickly obtained to bring resistant individuals indoors on occasions when leaving a person outdoors may subject him or her to danger from the cold weather elements.

“Code Blue’s success is best indicated by the rarity of hypothermia deaths among homeless persons in the past few years,” said Dr. Metraux. “But Code Blue is at best a stopgap solution; the best solution for protecting the homeless from the elements is through renewed efforts to reduce homelessness.”

The number of homeless people living on the streets across Philadelphia has been declining over the previous few years, due largely to innovative programs that engage the most recalcitrant homeless persons and provide them with housing and services, he said.

11/10/2014

A team of eight student-pharmacists from University of the Sciences joined more than 150 new volunteers with the Philadelphia Medical Reserve Corps as they acted out a bioterrorist attack which required them to administer antibiotics to thousands of Philadelphians to help prevent the spread of a deadly bacterial infection.

This dramatic, but informational, training session was held at USciences on Saturday, Nov. 8, for these credentialed volunteers – who are typically seen providing medical care and first aid after major storms, or at large city events such as the Philadelphia Marathon.

“Bringing together such a diverse group of local healthcare professionals and students was a positive experience which reinforced USciences’ mission of promoting integrated learning and professionalism,” said Steven Sheaffer, PharmD, associate professor of clinical pharmacy.

Although Dr. Sheaffer has been a member of the Medical Reserve Corps since 2007, he said regularly attends training sessions to keep up to speed with relief efforts and build stronger relationships with healthcare professionals across the Philadelphia region.

“I hope that more of our students across all disciplines consider attending future training programs and join the Medical Reserve Corps,” he said.

Aside from USciences pharmacy students and faculty, other volunteers at the training session included medical and doctoral students from University of Pennsylvania, nurses, as well as students and faculty from other local universities.

The Sept. 11, 2001, terrorist attacks on the World Trade Center and the mailing of anthrax-tainted letters to news media and U.S. senators painfully illustrated the need for more organized use of medical volunteers.

The Philadelphia Department of Public Health launched the city’s unit in 2005, after Congress allocated money to establish the Medical Reserve Corps program office in the U.S. Surgeon General’s Office. Philadelphia’s chapter now boasts more than 1,800 volunteers who offer their medical, pharmaceutical, behavioral health, and other skills.

“I wanted to volunteer for the medical corps to use my pharmacy education in way that allows me to give back to the community,” said Alex Fevry PharmD’17.

10/28/2014

University of the Sciences President Dr. Helen-Giles Gee, as well as students and faculty from USciences, joined hundreds of life sciences leaders and innovators during the Life Sciences Future Conference on Oct. 13-14 in Philadelphia.

Life Sciences Future was a two-day event designed by Pennsylvania Bio to reflect the rapidly-evolving landscape in healthcare - which includes biopharma, medical device and diagnostics, healthcare IT, contract research organizations, medical research institutions, and the investment community.

The first day of the event kicked off with Life Sciences Future Symposium: Partnerships in Science, which was designed for an exclusive audience of academic researchers, such as USciences students and faculty, to explore best practices for engaging business development representatives at large companies as well as the next steps in developing their technologies. The second day of the conference was jam-packed with speakers, topics and features all related to advancing science and healthcare industries.

Dr. Giles-Gee and students had the opportunity to meet and speak with Michael Sofia, inventor of Sofosbuvir – known by the brand name Sovaldi, a hepatitis C therapy drug approved by the FDA last December.

“The sessions were outstanding and much appreciated by the faculty and students who attended," Dr. Giles-Gee.

10/17/2014

Alumnus Patrick Connaghan PhB'14 is currently continuing his education and basketball career in Carlow, Ireland through the Sport Changes Life Foundation's Victory Scholarship program. He is pursing his Masters in Business at the Carlow Institute of Technology, and is on track to finish his degree this spring.

You can follow Patrick's journey in Ireland by following him at @Connaman on Twitter, or by reading his Sport Changes Life blog.

10/15/2014

Medication adherence is a growing concern for health care providers. For this reason many community pharmacies are focusing on was to increase medication adherence rates. This can be done in various ways ranging in diverse settings.

Medication therapy management (MTM) are services provided by pharmacists to increase therapeutic outcomes. There are approximately 1.5 billion preventable adverse effects that cause $177 billion in injury and death. A major target for MTM occurs in community pharmacies. The Pennsylvania Project studied 107 Rite Aid pharmacies that trained pharmacist to perform interventions including asking questions about medication adherence and 111 control pharmacies that did not perform these interventions. The endpoints of this study showed an increase in medication adherence (PDC >80%) in the intervention group over the control group. There was a significant increase in adherence of 3.1% for beta-blockers and 4.8% of for anti-diabetic drugs.

Patient counseling is a great way for community pharmacists to change medication adherence rates. In an internal study, Walgreens Pharmacy is creating a way to identify patients that may need a little more help with medication adherence by examining poor past medication adherence rates or new medications prescribed. In a study across 76 Walgreens, these interventions showed an increase in medication possession ratio.

Chronic medications can be difficult to control of especially if a patient is taking multiple medications. An AHRQ tool used in community pharmacies called refill reminders, can help patients pick up their medications on time. Using this script as part of an automated reminder system, can help prompt patients to refill their prescriptions or pick up their medication.

While at work, I have come across these methods to increase medication adherence in the community setting. It is important as pharmacist to intervene early by educating and counseling the patient, so adherence rates start off high. These methods have proven extremely beneficial in my place of work. For example, automatic courtesy refills allow all patients on maintenance medications to be reminded to pick up their medication, so they do not miss doses. These are just some examples of methods being implemented in community pharmacies to help pharmacists identify these patients and improve medication adherence.